Not all that glitters is COVID! Differential diagnosis of FDG-avid interstitial lung disease in low-prevalence regions

Abstract Coronavirus disease-19 (COVID-19) is only one of the many possible infectious and non-infectious diseases that may occur with similar imaging features in patients undergoing [18F]-fluorodeoxyglucose (18FDG) monitoring, particularly in the most fragile oncologic patients. We briefly summarise some key radiological elements of differential diagnosis of interstitial lung diseases which, in our opinion, could be extremely useful for physicians reporting 18FDG PET/CT scans, not only during the COVID-19 pandemic, but also for their normal routine activity.

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Differential Diagnosis of Pulmonary Fungal Infection and Lung Cancer via 18F-FDG PET/CT: A Retrospective Study

10.21203/rs.3.rs-191078/v1 ◽

2021 ◽

Author(s):

Xin Feng ◽

Chunmei Deng ◽

Xiaofeng Li ◽

Ye Qiu ◽

Jiehua Deng ◽

...

Keyword(s):

Lung Cancer ◽

Differential Diagnosis ◽

Fungal Infection ◽

Fdg Pet ◽

Pathological Examination ◽

Imaging Features ◽

Antigen Test ◽

Fdg Uptake ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Background: There is limited evidence regarding the 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) characteristics of lung fungal (LF) infections with nodules or masses, which are often misdiagnosed as lung cancer (LC) with indications for surgery. We aimed to investigate the PET/CT findings of LF infections with nodules in comparison to those of LC and clarify the diagnostic value of 18F-FDG PET/CT in the differential diagnosis of LF infections.Methods: We enrolled 21 patients who presented with pulmonary nodules or masses on CT, were diagnosed with LF infections, and underwent PET/CT as the LF group and randomly selected 42 patients with LC diagnosed by pathology as the LC group. Clinical and PET/CT imaging data were statistically analyzed.Results: LC was the most common misdiagnosed disease in the LF group (52.38%). There were no significant differences in lung imaging features between the two groups. The levels of white blood cells, neutrophils, and IgG and the positive rates for fungal antigen test in the LF group were significantly higher than those in the LC group (P<0.05). Lung masses larger than 3 cm were more common in the LC group (P<0.05). Overall, 80.95% (17/21) of patients in the LF group showed increased 18F-FDG uptake. There were no significant between-group differences in the maximal standardized uptake value (SUVmax, 8.20 [2.70, 12.95] vs. 8.80 [7.00, 12.38]). In the LF group, eight, five, and eight patients had cryptococcal, Aspergillus, and Talaromyces marneffei infections, respectively, with no significant difference in SUVmax among them (5.10 [1.70, 14.40] vs. 8.20 [1.50, 8.20] vs. 8.50 [5.10, 11.30]). Conclusions: Both LF infection and LC can present with increased 18F-FDG uptake on PET/CT. Thus, it is difficult to distinguish between them according to lung PET/CT and CT manifestations. Patients presenting with pulmonary masses should also be suspected to have fungal infection, even those with an increased SUVmax and simultaneous lymph node and bone involvement; particular attention is needed for patients with abnormal inflammation indexes and fungal antigen test. We should be emphasized preoperative pathological examination and fungal etiology.

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Correlation of 18F-FDG PET/CT SUVmax with clinical features, D-dimer and LDH in patients with primary intestinal lymphoma

Journal of International Medical Research ◽

10.1177/03000605211029809 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110298

Author(s):

Shuo Zhou ◽

Wenxin Chen ◽

Meifu Lin ◽

Guobao Chen ◽

Cailong Chen ◽

...

Keyword(s):

Fdg Pet ◽

Clinical Staging ◽

Imaging Features ◽

Intestinal Lymphoma ◽

Ki 67 ◽

Positive Correlation ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

D Dimer

Objective To investigate the characteristics of fluorine-18-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) maximum standardized uptake value (SUVmax) in primary intestinal lymphoma (PIL) and its correlation with D-dimer and lactate dehydrogenase (LDH). Methods Fifty-two patients diagnosed with PIL from June 2016 to December 2019 were analyzed. All patients underwent 18F-FDG PET/CT. The relationships between SUVmax and different pathological subtypes, clinical stages and risk grades were analyzed. The correlations between SUVmax and Ki-67, LDH and D-dimer were determined. Additionally, PET/CT imaging results were collected from 35 patients with primary intestinal cancer (PIC) and compared with the imaging features of PIL. Results SUVmax was significantly different between PIL and PIC groups and various PIL pathological subgroups. Patients in the high-risk PIL group had markedly higher SUVmax values than the intermediate-risk and low-risk groups. A significant positive correlation was observed between SUVmax and Ki-67 in patients with PIL. SUVmax was significantly different between the elevated and normal D-dimer groups. D-dimer showed a positive correlation with SUVmax. Conclusion 18F-FDG PET/CT SUVmax reflects the aggressiveness of lymphoma to a certain degree, is correlated with Ki-67 and determines the risk grades of PIL. Moreover, it facilitates differential diagnosis, clinical staging and treatment based on D-dimer levels.

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Automated quantification of baseline imaging PET metrics on FDG PET/CT images of pediatric Hodgkin lymphoma patients

EJNMMI Physics ◽

10.1186/s40658-020-00346-3 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Amy J. Weisman ◽

Jihyun Kim ◽

Inki Lee ◽

Kathleen M. McCarten ◽

Sandy Kessel ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Correlation Coefficient ◽

Pet Imaging ◽

Fdg Pet ◽

Relative Difference ◽

Ct Images ◽

Imaging Features ◽

Pediatric Hodgkin Lymphoma ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Purpose For pediatric lymphoma, quantitative FDG PET/CT imaging features such as metabolic tumor volume (MTV) are important for prognosis and risk stratification strategies. However, feature extraction is difficult and time-consuming in cases of high disease burden. The purpose of this study was to fully automate the measurement of PET imaging features in PET/CT images of pediatric lymphoma. Methods 18F-FDG PET/CT baseline images of 100 pediatric Hodgkin lymphoma patients were retrospectively analyzed. Two nuclear medicine physicians identified and segmented FDG avid disease using PET thresholding methods. Both PET and CT images were used as inputs to a three-dimensional patch-based, multi-resolution pathway convolutional neural network architecture, DeepMedic. The model was trained to replicate physician segmentations using an ensemble of three networks trained with 5-fold cross-validation. The maximum SUV (SUVmax), MTV, total lesion glycolysis (TLG), surface-area-to-volume ratio (SA/MTV), and a measure of disease spread (Dmaxpatient) were extracted from the model output. Pearson’s correlation coefficient and relative percent differences were calculated between automated and physician-extracted features. Results Median Dice similarity coefficient of patient contours between automated and physician contours was 0.86 (IQR 0.78–0.91). Automated SUVmax values matched exactly the physician determined values in 81/100 cases, with Pearson’s correlation coefficient (R) of 0.95. Automated MTV was strongly correlated with physician MTV (R = 0.88), though it was slightly underestimated with a median (IQR) relative difference of − 4.3% (− 10.0–5.7%). Agreement of TLG was excellent (R = 0.94), with median (IQR) relative difference of − 0.4% (− 5.2–7.0%). Median relative percent differences were 6.8% (R = 0.91; IQR 1.6–4.3%) for SA/MTV, and 4.5% (R = 0.51; IQR − 7.5–40.9%) for Dmaxpatient, which was the most difficult feature to quantify automatically. Conclusions An automated method using an ensemble of multi-resolution pathway 3D CNNs was able to quantify PET imaging features of lymphoma on baseline FDG PET/CT images with excellent agreement to reference physician PET segmentation. Automated methods with faster throughput for PET quantitation, such as MTV and TLG, show promise in more accessible clinical and research applications.

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Differential Diagnosis of Neurodegenerative Dementias Using Metabolic Phenotypes on F-18 FDG PET/CT

The Neuroradiology Journal ◽

10.15274/nrj-2014-10002 ◽

2014 ◽

Vol 27 (1) ◽

pp. 13-21 ◽

Cited By ~ 21

Author(s):

Madhavi Tripathi ◽

Manjari Tripathi ◽

Nishikant Damle ◽

Suman Kushwaha ◽

Abhinav Jaimini ◽

...

Keyword(s):

Differential Diagnosis ◽

Fdg Pet ◽

Metabolic Phenotypes ◽

Pet Ct ◽

Fdg Pet Ct ◽

Neurodegenerative Dementias

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FDG PET/CT imaging features and clinical utility in COVID-19

Clinical Imaging ◽

10.1016/j.clinimag.2021.08.002 ◽

2021 ◽

Author(s):

Randy Yeh ◽

Ahmed Elsakka ◽

Rick Wray ◽

Rocio Perez Johnston ◽

Natalie C. Gangai ◽

...

Keyword(s):

Fdg Pet ◽

Clinical Utility ◽

Ct Imaging ◽

Imaging Features ◽

Pet Ct ◽

Fdg Pet Ct

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Comparative Performance of 18F-FDG PET/MRI and 18F-FDG PET/CT in Detection and Characterization of Pulmonary Lesions in 121 Oncologic Patients

Journal of Nuclear Medicine ◽

10.2967/jnumed.115.167486 ◽

2016 ◽

Vol 57 (4) ◽

pp. 582-586 ◽

Cited By ~ 34

Author(s):

L. M. Sawicki ◽

J. Grueneisen ◽

C. Buchbender ◽

B. M. Schaarschmidt ◽

B. Gomez ◽

...

Keyword(s):

Fdg Pet ◽

Comparative Performance ◽

Pulmonary Lesions ◽

Pet Ct ◽

Oncologic Patients ◽

18F Fdg ◽

Fdg Pet Ct

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Is 18F-FDG PET/CT capable of differential diagnosis from tuberculous pleurisy from malignant mesothelioma?

Nuclear Medicine Communications ◽

10.1097/mnm.0000000000001375 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Özlem Özmen ◽

Ebru Tatci ◽

Ş. Mustafa Demiröz ◽

Zuhal Tazeler ◽

Funda Demirağ

Keyword(s):

Differential Diagnosis ◽

Malignant Mesothelioma ◽

Fdg Pet ◽

Pet Ct ◽

Tuberculous Pleurisy ◽

18F Fdg ◽

Fdg Pet Ct

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18F FDG PET-CT Imaging in Tuberculosis

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v19i2.36011 ◽

2018 ◽

Vol 19 (2) ◽

pp. 135

Author(s):

Shamim MF Begum ◽

Md Abdus Shakur Khan

Keyword(s):

Computed Tomography ◽

Fdg Pet ◽

Ct Imaging ◽

Medical Emergency ◽

Imaging Features ◽

Conventional Imaging ◽

Imaging Tool ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

<p>Tuberculosis (TB) is the second highest infective cause of death worldwide and the global impact of TB is very important. Among all the TB burden WHO regions, 40% TB cases accounts in the South East Asian region. It has become a medical emergency not only in developing countries but also in some high-income countries. The rising incidence of multidrug resistance (MDR) TB and HIV co-infection has increased the morbidity and mortality of TB despite the availability of cheap and effective treatment. The diagnosis of active TB is almost similar over the world. Conventional radiography and Computed Tomography (CT) imaging play a crucial role in the diagnosis of TB. But these conventional imaging are often nonspecific and unable to provide a definitive diagnosis in cases of atypical and heterogeneous presentation. The signs of TB may mimic other diseases in conventional imaging. The introduction of new imaging tool Fluorine18 Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (18F FDG PET-CT) opens the door to evaluate its potentiality application in TB. The role of this new imaging tool in TB imaging has been well documented. 18F FDG PET-CT may assist in early diagnosis, facilitate differentiation between malignancies and TB, identification of extrapulmonary TB, staging of TB, and in assessment of treatment response. Therefore, familiarity with the spectrum of imaging features and understanding the use of 18F FDG PET-CT in diagnosis and management of TB is important, especially for referring clinicians and the reporting nuclear medicine specialists in TB burden country like Bangladesh. This article reviews the main applications, pattern of imaging spectrum with limitations of 18F FDG PET-CT in TB.</p><p>Bangladesh J. Nuclear Med. 19(2): 135-140, July 2016</p>

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